Overview

Provides data reporting and analysis projects for Provider Operations. Monitors, analyzes and presents summary analyses regarding the Plan's provider network. Prepares data load files from disparate sources for loading to consolidated data systems. Completes end to end process for all Provider Directories, including vendor files. Serves at the Provider Relations Department's data expert. Works under general direction.

Compensation Range:$85,000.00 - $106,300.00 Annual

What We Provide

• Referral bonus opportunities     
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays   
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability    
• Employer-matched retirement saving funds   
• Personal and financial wellness programs    
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care   
• Generous tuition reimbursement for qualifying degrees   
• Opportunities for professional growth and career advancement    
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities  

What You Will Do

• Develops and manages data analysis and reporting projects/assignments and ensures forward momentum of projects toward stated goals. Monitors project work plans, including objectives, tasks and time frames, to ensure deliverables are completed on time. Identifies and responds to changing project circumstances and communicates issues to project leadership.
• Ensures that all data from internal and external sources is retrieved, reviewed, and compiled, appropriately. Researches and corrects discrepancies, as needed. Identifies and fixes data quality issues.
• Compiles and reviews provider network data regarding network deficiencies and gaps. Makes recommendations to address identified areas of opportunity.
• Designs and implements queries, reports, etc.. Creates and summarizes data in analytical reports that include tables, graphs, statistical analyses, and qualitative and quantitative analyses. Reviews and identifies trends and variances in data and reports.
• Creates production reports and conducts ad hoc analyses to provide information to senior leadership, health plan management, departmental colleagues, and external organizations, including the Department of Health, CMS, etc. Provides narrative interpretation to clarify findings as needed.
• Initiates and maintains relationships with various departments, including but not limited to, Claims, Membership and Eligibility, Health Economics, Quality Management, and Information Systems to secure current and accurate data. Collaborates with all report recipients to incorporate their needs and expectations into the reports in order to improve the quality of the work.
• Functions as the lead/subject matter expert by providing support to department leadership with analytical projects and by developing department workflows and project plans
• Initiates and maintains internal contacts to secure current/correct data necessary for clear presentations of all reports, special projects, etc.
• Documents departmental workflows concerning provider databases, provider data entry and maintenance, and regulatory reporting. Develops user guides and related documentation for report generation, as needed.
• Reviews and identifies trends and variances in data and reports. Researches findings and determines appropriateness of elevating identified issues to leadership for further review/evaluation/action.
• Ensures compliance with SDOH and CMS regulatory reporting requirements, including but not limited to Health Provider Network (HPN), Health Services Delivery (HSD), Medicare Part C reporting, provider directories, etc.
• Provides guidance and narrative interpretation to clarify and explain findings, as needed.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

• Bachelor's Degree or equivalent work experience in a health-care related environment required
• Master's Degree in same preferred

Work Experience:

• Minimum four years data analysis experience, including experience in provider data analysis required
• Advanced proficiency in MS Excel (including formulas, sorts, filters, pivot tables, IF statements, VLOOKUP, HLOOKUP, etc.), MS Access (criteria statements, table links, and database and report creation), and MS Word required
• Ability to create Crystal reports, SQL programming and SAS Base 9 programming required
• Effective oral, written and interpersonal communication skills required
• Knowledge of Medicare Advantage and Medicaid regulatory reporting preferred